Mtp Pearls


    Mtp Pearls

    32M BIBEMS s/p SW to abdomen. He becomes hypotensive/tachycardic, becomes less responsive. Massive transfusion protocol is initiated.

    • What electrolyte abnormality is caused by massive transfusion?
    • In the 1:1:1 ratio, are we talking about a single dose of platelets or a single unit of platelets?

    1) Due to large quantity of citrate being administered (~3g citrate per unit of RBC), massive transfusion can lead:

    • Hypocalcemia – Citrate binds to ionized calcium. Look out for signs of hypocalcemia including tetany, hypotension, prolonged QTc. Monitor ionized calcium level
    • Hyperkalemia (especially if using older blood and in patients with CKD)
    • Metabolic alkalosis (citrate metabolism produces HCO3)

    *Citrate is metabolized by the liver, so inc risk in patients with hepatic dysfunction.

    2) The 1:1:1 refers to Plasma:PLT:RBC where the PLT is measured in units

    • 1 adult dose of platelets = 1 unit of apheresis platelets = 5-6 units of random donor platelet units

    (i.e. 6U plasma:1 dose of platelets:6U RBCs)


    Click here for review of the landmark PROPPR trial. <>



    • Holcomb et al. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma. JAMA. 2015;313(5):471-482.
    • Spinella PC, Holcomb JB. Resuscitation and transfusion principles for traumatic hemorrhagic shock. Blood Rev. 2009 Nov;23(6):231-40.